US5221258A - Introduction balloon catheter - Google Patents
Introduction balloon catheter Download PDFInfo
- Publication number
- US5221258A US5221258A US07/643,919 US64391991A US5221258A US 5221258 A US5221258 A US 5221258A US 64391991 A US64391991 A US 64391991A US 5221258 A US5221258 A US 5221258A
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- Prior art keywords
- balloon
- passageway
- catheter
- distal end
- shaft
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- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Lifetime
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M2025/0183—Rapid exchange or monorail catheters
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
Definitions
- the invention relates to catheters for use in bodily passageways, and more particularly to a balloon catheter usable to introduce over-sized or large-bore objects into restricted passageways in the body, such as veins or arteries and the like, and particularly into atherosclerotic arteries.
- Catheterization of vascular and other passageways in the body is a well known technigue used to accomplish a variety of tasks, including draining fluids from the body, introducing fluids (such as imaging fluids) into the passageways, performing repair procedures (such as angioplasty) and so forth.
- catheters are ever growing, owing at least in part to the attractiveness of being able to accomplish certain invasive tasks that otherwise would reguire surgery or sometimes even open heart surgery.
- Catheter procedures in lieu of surgery typically are less traumatic to the patient, and often reduce or eliminate many of the risks associated with surgery.
- catheter procedures usually are much cheaper than surgery, if for no other reason that in-hospital recovery time is often significantly reduced or eliminated.
- balloon catheters have been used in coronary angioplasty for opening narrowed (atherosclerotic) coronary arteries.
- a guidewire is advanced into the artery, followed by a balloon catheter.
- the balloon is properly positioned (as determined by conventional radiological imaging) and then inflated.
- the balloon dilates the narrowed section of the artery, compressing the plague and slightly stretching the artery to widen the blood passageway.
- the balloon is then deflated, and may be advanced to another stenosis, or removed upon completion of the desired procedure.
- Detailed descriptions of such procedures may be found in, e.g., G. Jang. Angioplasty (1986).
- catheters are also useful for providing a secure passageway through which small devices may be delivered to remote locations in the body.
- catheters There are many desired uses for such catheters, however, that heretofore have been impossible or impractical due to the size of the device desired to be delivered through a passageway.
- the size of such devices is necessarily limited by the internal diameter of the catheter, and the size of the catheter in turn is limited by the internal diameter (and other factors, such as tortuosity, atherosclerotic plague, etc.) of the passageway itself.
- the invention provides an apparatus and method for delivering otherwise oversized devices through passageways in the body.
- the apparatus comprises an elongated inflatable balloon having an inner diameter slightly larger than the outer diameter of the device to be introduced into the passageway.
- a guidewire may be attached to the distal end of the balloon to assist introduction of the balloon into the bodily passageway.
- a device introduction chamber is attached at the proximal end of the balloon for temporarily housing the device being introduced into the passageway, and the device itself includes a delivery shaft at 1east partia11y disposed in the introduction chamber.
- Inflation means is provided for inflating the balloon once the balloon has been inserted into the bodily passageway.
- the device is particularly useful in traversing narrowed portions of a bodily passageway, such as introducing a device through the narrowed (particularly atherosclerotically narrowed) femoral artery into the wider abdominal aorta.
- the method therefore comprises the steps of inserting at least the distal portion of the uninflated balloon into the bodily passageway (preferably advancing at least the distal end past the narrowed portion of the passageway that must be traversed), inflating the balloon to expand and straighten (if necessary) the passageway, and then advancing the device from the introduction chamber into the distal portion of the balloon.
- the balloon is configured so that the device can be freed from the balloon. Preferably this is accomplished by configuring the balloon so that it can be ruptured near its distal end to free the device, allowing the device to be advanced through the wider passageway to its destination (such as advancing through the aorta to the heart). Such rupture may be accomplished through any suitable means.
- the rupture in the balloon is longitudinally oriented, and thus, in a particularly preferred embodiment, the balloon includes a longitudinal weakness so that upon over-inflation of the balloon the balloon will rupture along the longitudinal weakness.
- the balloon may include a distal portion that is of a larger diameter than the rest of the balloon so that upon over-inflation a longitudinal rupture will occur in the distal, larger portion.
- the balloon catheter desirably includes a shaft engaged at its distal end to the distal end of the balloon.
- the shaft preferably is removable by disengaging it from the distal end of the balloon (as by unscrewing threads or merely pulling it loose from a friction fit or retracting it from a nonfriction site of engagement) and withdrawing it through a port in the introduction chamber to allow the device to be advanced into the balloon withcut interference from the shaft.
- FIG. 1 shows an introduction balloon catheter of the invention with the guidewire inserted into the femoral artery, through the iliac artery, with the distal end entering the abdominal aorta;
- FIG. 2 shows an introduction balloon catheter of the invention with the uninflated balloon advanced into the femoral artery and partially into the abdominal aorta;
- FIG. 3 shows an introduction balloon catheter of the invention inserted into the femoral artery and aorta with the balloon inflated;
- FIG. 4 shows the introduction balloon catheter of FIG. 3 with the balloon shaft retracted
- FIG. 5 shows the introduction balloon catheter of FIG. 4 with the device advanced into the distal portion of the balloon in the aorta;
- FIG. 6 shows the introduction balloon catheter of FIG. 5 with the balloon ruptured and the device partially advanced out of the balloon
- FIG. 7 shows the introduction balloon catheter of FIG. 6 with the ruptured balloon removed from the artery
- FIG. 8 shows placement of a prosthetic vascular graft attached to the vascular entry wound, tied off around the delivery shaft to prevent blood leakage;
- FIG. 9 shows an introduction balloon catheter of the invention having a balloon with a longitudinally weakened portion near its distal end
- FIG. 10 is a cross-sectional view of FIG. 9 taken along line 10--10 thereof;
- FIG. 11 is a cross-sectional view similar to FIG. 10 but after the balloon has ruptured;
- FIG. 12 shows an introduction balloon catheter of the invention having a balloon with a wider distal portion
- FIG. 13 shows an introduction balloon catheter of the invention where the device being inserted into the bodily passageway includes a catheter through which inflation fluid is delivered to the balloon;
- FIG. 14 shows an introduction balloon catheter of the invention wherein the balloon shaft comprises a catheter through which inflation fluid may be delivered;
- FIG. 14A in an enlarged view of the distal end of the catheter of FIG. 14;
- FIG. 15 is a broken-away, crrss-sectional view of the distal end of the balloon catheter of the invention.
- FIG. 16 is a broken-away, cross-sectional view similar to FIG. 15 of an alternate embodiment of the invention.
- FIGS. 17-18 show yet another cross-sectional view similar to FIG. 16 of an alternate embodiment of the invention.
- FIG. 19 shows a removal balloon catheter useful in conjunction with the introduction balloon catheter of the invention
- FIGS. 20-21 show another removal balloon catheter similar in function to the removal balloon catheter of FIG. 19;
- FIGS. 22-23 show consecutive steps in use of yet another apparatus useful in assisting removal of a device from a bodily passageway
- FIG. 24 shows an alternate embodiment of the apparatus of FIGS. 22-23;
- FIG. 25 shows an introduction balloon catheter of the invention that has been preformed to have certain curves when it is inflated
- FIG. 26 shows a simplified version of the introduction balloon catheter of the invention
- FIGS. 27-29 show a configuration and method for reducing the volume of fluid released into the vessel when the balloon catheter is ruptured
- FIG. 30 shows an alternate embodiment similar to FIGS. 27-29;
- FIG. 31 shows an alternate embodiment of the introduction balloon catheter of the invention having an additional stiffening shaft about the device delivery shaft;
- FIGS. 32-34 show an alternate embodiment wherein the balloon shaft is positioned external to the balloon
- FIG. 35 shows the distal end of an alternate embodiment of the invention that does not utilize a guidewire
- FIGS. 36-37 show alternate embodiments that include additional means for utilizing a guidewire with the balloon introduction catheter of the invention.
- FIGS. 38-39 depict a method of using the balloon introduction catheter of the invention to insert and remove a large bore catheter or cannular from an artery.
- FIGS. 1-7 depict the series of steps involved in utilizing the introduction balloon cathter of the invention.
- the introduction balloon catheter is usable in a variety of bodily passageways, including but not limited to the vascular system, the urinary system, the digestive system, and the like. It is particularly useful for introducing devices of a diameter large enough that insertion with conventional introducers, sheaths or catheters is difficult or impossible. Typically, this will occur when the device (80) is of a diameter larger than, equal to, or approaching the diameter of the passageway.
- the introduction balloon catheter of the invention is particularly useful when the passageway may be partially occluded, such as by atherosclerotic plaque, and when the passageway is somewhat tortuous, as is often the case in elderly patients.
- the invention is particularly useful when the deivce is being introduced through a passageway that is narrow along a part of its path, but then widens, as in the case of introducing devices through the femoral artery to the aorta (and then to the heart itself), or, e.g., through the urethra to the bladder or past any partial blockage in a passageway.
- FIG. 1 For purposes of illustrating use of the invention, the drawings depict use of the invention for advancing a device (80) through the femoral and iliac arteris (22) into the abdominal aorta (20).
- Artery (22) is herein frequently referred to as the femoral artery, but it should be understood that the portion of this artery adjacent to the aorta is called the iliac, and references herein to the femoral artery usually are equally applicable to the iliac portion of this artery.
- the introduction balloon catheter of the invention includes an elongated balloon (33) having a distal end (34) and a proximal end (35).
- a guidewire (37) desirably is attached at its proximal end (39) to the distal end (34) of the balloon (33) (though, as described below, other configurations are also possible).
- the distal end (40) of the guidewire (37) may be straight, may include a safety J-tip, or be of any other suitable configuration.
- the proximal end (35) of the balloon (33) is attached to an introduction chamber (50), which temporaily houses the device (80) to be introduced into the artery.
- the introduction chamber (50) includes a main chamber portion (52), which houses the device (80), and may include one or more additional ports. In the preferred embodiment shown in FIGS. 1-5, the introduction chamber (50) includes two additional ports.
- a fluid port (66) is provided to facilitate inflation of the balloon by injection of a fluid (77), and a balloon shaft port (60) is also provided to facilitate removal of the balloon shaft (42), as described in greater detail below.
- the main chamber (52) and the balloon shaft port (60) of the introduction chamber (50) both include threaded compression fittings (54) and (61), respectively, with sealing rings (57) and (62), respectively, for allowing insertion and/or withdrawal of the device delivery shaft (81) and balloon shaft (42), as desired.
- These fittings mayb e tightened against their respective sealing rings to prevent excessive escape of fluid (77), and also may be loosened to facilitate easier advancement or retraction of the shaft (81) and shaft (42).
- An inflation device (69) is attached to the fluid port (66) by a suitable fitting (67).
- the inflation device typically comprises a syringe (71) having a plunger (72) for injecting a fluid to inflate the balloon (33).
- a stop-cock (73) may be provided to maintain the desired volume of fluid (and therefore the pressure) in the balloon once the plunger (72) has been depressed or withdrawn to inject/withdraw the fluid (77).
- two or more syringes (71), attached in parallel fashion, can be used if desired, particularly if a significant volume of fluid (77) is required.
- FIGS. 1-7 depict a preferred embodiment for use of the introduction balloon catheter.
- FIG. 1 shows the introduction balloon catheter with the guidewire (37) inserted into vascular incision (25), the guidewire passing through the femoral and iliac arteries into the abdominal aorta (20). Insertion may be accomplished through known techniques, including percutaneous vascular catherterization, or use of a cutdown. In many cases, a cutdown will be preferred due to the size of the catheter and the consequent size of the required incision (25).
- the guidewire (37) can be advanced through the femoral artery (22), past any plaque deposits (27) that may have accumulated in the artery, navigating through even a somewhat tortuous path until the distal tip (40) of the guidewire (37) reaches the much wider abdominal aorta (20).
- the length of the guidewire desirably is selected according to the length of the artery that must be navigated so that the tip reaches the aorta before any significant portion of the uninflated balloon (33) is inserted into the incision. If desired, however, a shorter guidewire may also be used.
- the device may be further advanced so that the uninflated balloon (33) advances into the femoral artery and partially into the aorta, as shown in FIG. 2.
- FIG. 35 shows an alternate embodiment that does not utilize a guide wire--the distal end of the balloon (shown in inflated condition) tapers to a tip that does not utilize a guidewire.
- FIGS. 36-37 show yet further alternate embodiments wherein the balloon catheter includes a distal tip portion having a lumen (29); the lumen includes a side port 30 (FIG. 36) near the proximal end of the tip portion through which the guidewire (37) enters the lumen (29).
- FIG. 37 shows a slightly different configuration for the port (30').
- the guidewire (37) desirably is first advanced the desired distance into the vascular passageway, and the distal tip porticn of the balloon catheter with the lumen (29) (along with the balloon) is then advanced over the guidewire. Once the balloor catheter is in proper position, the guidewire may be either left in place or withdrawn, as desired.
- An advantage of this configuration is that it allows the guidewire to have a conventional steerable tip, if desired, and the length that the guidewire advances into the vascular passageway can be controlled independent of advancement of the balloon into the passageway.
- the balloon may be inflated.
- the balloon should be advanced sufficiently far so that the length of the balloon in the abdominal aorta (i.e., in the wider portion of the bodily passageway) exceeds the length PG,14 of the device (80) being delivered. In this way the device (80) can be advanced completely through the more narrow portion of the passageway and into the wider portion of the passageway before the device (80) is freed from the balloon.
- FIG. 3 shows that the plunger (72) of the syringe (71) has been depressed to inject the fluid (77) through the fluid port (66) into the balloon (33), thereby inflating the balloon to its full diameter.
- the inflated, stiffened balloon (33) tends to straighten the tortuosity of the passageway (in this case, the femoral artery (22)), and simultaneously performs a balloon angioplasty on any plague (27) that may be partially occluding the artery (22).
- the balloon shaft (42) may be removed, as shown in FIG. 4. Detachment of the distal end (44) of the shaft (42) from the distal fitting (36) of the balloon (33) may be accomplished by unscrewing complementary threads in the two parts, by merely pulling on the shaft against a friction fit between the tw,o parts, or by retracting it from a nonfriction site of abuttment (or by any other suitable fashion). As shown in FIG. 4, the shaft need not be completely removed from the shaft port (60), but may, if desired, be merely withdrawn sufficiently to be out of the way of advancement of the device (80) frcm the introduction chamber (50) into the balloon (33).
- the device (80) may be advanced through the balloon without being restricted by the otherwise tortuous and possibly plague laden artery (22) into the distal portion of the balloon (33) located in the abdominal aorta (20), as shown in FIG. 5.
- the balloon is ruptured near its distal end (34), freeing the device (80) to be further advanced through the aorta toward its destination, as shown in FIG. 6.
- the ruptured balloon may then be withdrawn from the artery (22), as shown in FIG. 7.
- Rupture of the balloon may be accomplished by any suitable means or method. If the distal tip of the device (80) being advanced through the balloon includes any retractable/controllable sharp or cutting surfaces, these may be used to puncture the distal end (34) of the talloon (33). Alternately, and preferably, however, the balloon may be ruptured by increasing the pressure of the fluid (77) from the inflation device (69) until the balloon ruptures from the over-pressure. The site of the rupture in the ballocn can be controlled by manufacturing the balloon in any one of several ways. FIGS. 9-10 depict a balloon having a longitudinal segment of weakngss manufactured into the balloon which will rupture when excessive pressure is applied to the fluid (77) in the balloon. FIG. 11 shows fluid escaping from the balloon after the rupture has occurred.
- FIG. 12 depicts another embodiment in which the balloon has a wider (i.e. a larger diameter) distal portion (47).
- the excessive hoop stress i.e., circumferential tension
- the wider portion will cause this portion to rupture before the narrower portions of the balloon rupture.
- t:he rupture occur as a longitudinal split in the balloon, rather than a transverse split.
- a longitudinal split (as shown in FIG. 6) allows the device to more easily escape the balloon, and also assures that the distal portion (34) of the balloon (33) does not become separated from the proximal end (35) of the balloon.
- any other suitable means and methods may also be used to release the device (80) from the balloon. Moreover, in some circumstances, it may not even be necessary to release the device from the balloon, depending upon the task being accomplished by the device (80).
- a prosthetic vascular graft (85) will have been sutured to the artery prior to introduction of the balloon and the device, as shown in FIG. 8.
- the graft may then be secured about the delivery shaft (81) to prevent escape of blood but permitting later removal of the device (80).
- the device (80) is of the type intended to be left in the patient only temporarily, the device can later be withdrawn using the device delivery shaft (81).
- the mere fact that it is easier to withdraw a device by pulling than to advance a device by pushing will be sufficient to allow removal of the device (80) by merely pulling on the shaft (81).
- the fact that an angioplasty has been performed on the artery by the balloon (33) will make withdrawal easier than it otherwise would have been.
- assistance may be needed in withdrawing the device (80) through the femoral artery (22).
- FIGS. 19-24 depict several embodiments of devices helpful in withdrawing the device (80).
- FIG. 19 shows a withdrawal balloon catheter (100) having an elongated configuration and a balloon with a rather blunt distal end (101).
- the balloon catheter includes a central lumen through which the device delivery shaft (81) is received, and a proximal Y-connector (103) to which an inflation syringe (104) is connected.
- the device (80) is withdrawn as far as possible without the aid of the withdrawal balloon catheter (100).
- the balloon catheter (100) is then inserted to a position abutting the proximal end of the device (80), and the balloon is then inflated by the inflation syringe (104). This expands the portion of the artery at the proximal end of the device (80).
- the balloon catheter (100) is then deflated, withdrawn slightly, and reinflated to again expand the artery sufficiently (as shown in FIG. 19) to facilitate withdrawal of the device (80) a short distance until the proximal end of the device again abuts the distal end (101) of the balloon catheter (100).
- the balloon catheter is deflated, withdrawn a short distance, and reinflated, allowing the device (80) to be withdrawn another short distance.
- the device can be withdrawn the reguired distance, past the tortuous or narrowed portions of the artery (22) until it either has exited the incision (25) or can be freely withdrawn the rest of the way without further aid from the withdrawal balloon catheter (100).
- FIGS. 20-21 show a slightly different version of the withdrawal balloon catheter, wherein the balloon (106) is relatively short but retains the blunt distal end (107).
- the blunt distal end of the balloon on bcth versions of the withdrawal balloon catheters is desirable, as it allows the proximal end of the device (80) to closely approach the full widened diameter of the balloon--if the distal end of the balloon tapers more gently, the effectiveness in expanding the artery adjacent the proximal end of the device (80) is lessened.
- FIGS. 22-24 depict yet further embodiments of withdrawal devices usable with present invention.
- a tapered fairing (109) is carried on the device delivery shaft (81) proximal of the device (80).
- the outer diameter of the fairing (109) at its distal end preferably matches the outer diameter of the prcximal end of the device (80).
- the fairing (109) then tapers to become narrower at its proximal end.
- a stop (110) is provided on the device delivery shaft proximal of the device (80) to advance the fairing (109) during introcution of the device and to keep the fairing (109) from drifting downstream during the time the device is in the patient.
- the delivery shaft (81) When the device is to be removed from the patient, the delivery shaft (81) is withdrawn, permitting the fairing to enter the smaller artery (22). When any resistance in the artery (22) is encountered, the fairing slides along the shaft (81) until it abuts the device (80), whereupon the two together may be pulled through the artery (22), the fairing acting to expand any narrowed portions of the artery (22).
- FIG. 24 shows a slightly different embodiment, wherein the proximal end of the fairing (111) includes an inner conical section sized to receive the distal end of a conventionally tapered withdrawal balloon (112)--such balloons may be easier to manufacture than the blunt-end balloons shown in FIGS. 19, 20-21, and the fairing (111) here serves to convert the distal end of such tapered balloons into a more blunt configuration.
- the fairing may be manufactured from silicone, pyrolytic carbon, or any other biocompatible materials.
- the balloon (33) may be manufactured from known balloon materials. Typically, such balloons are made from a biologically compatible material that is not significantly stretchable. This allows careful selection of the size of the balloon to correspond to the diameter of the artery (or other passageway) through which the device (80) is to be introduced. That is, upon inflation of the balloon, the balloon will inflate to its predetermined size, and not larger. Moreover, upon over-inflation of the balloon, the balloon will not continue to distend and further expand the artery (which, at some point would become dangerous). Rather, the balloon will rupture, typically at its weakest point which, as discussed above, desirably will be near its distal end where the balloon has been manufactured with a predisposition to rupture in a longitudinal fashion.
- the balloon Prior to inflation, the balloon may be closely furled about the balloon shaft (42) for ease of insertion and advancement of the balloon through the bodily passageway. This can be accomplished by any suitable r:ethod ordinarily used with conventional angioplasty balloons, including drawing a vacuum on the balloon with the inflation device (69), and/or during manufacture of the device by gently securing the balloon (33) in a furled configuration. If necessary, assistance for retaining the balloon in a furled configuration can be obtained by use of a biocompatible adhesive such as sugar or other similar substances. Also, to reduce excessive stress on the artery (or other passageway) due to the straightening of the balloon, the balloon may be manufactured with predetermined, slight curves, as shown in FIG. 25. Such curves should be gentle enough to permit easy advancement of the device (80).
- the balloon shaft (42) serves mainly to give the balloon catheter good pushability, i.e., make the uninflated balloon catheter rigid enough so that it can be advanced into the bodily passageway.
- the shaft (42) may be manufactured from any suitable plastic, metal, composite, or other suitable material or combinations of materials, but should be sufficiently flexible to permit it to navigate the curves of the bodily passageway. Desirably it is also radiopague. If the balloon itself can be manufactured to be stiff enough in its furled but uninflated configuration, the balloon shaft (42) could be omitted. Also, although the shaft (42) is depicted in the drawings as being located generally coaxially of the inflated balloon (33), the shaft (42) could also be attached to one wall of the balloon (33).
- the shaft (42) could be located outside the balloon, with the balloon externally attached to the shaft as shown in FIGS. 32-34.
- the balloon shaft (42) desirably includes a central lumen through which the guidewire (37) may pass, and the balloon, (shown uninflated in FIG. 32) includes a distal loop (31) through which the guidewire (37) passes and against which the balloon shaft (42) pushes when the balloon is advanced into the artery.
- FIGS. 33 and 34 illustrate that the guidewire (37) may be withdrawn into the shaft (42) after the balloon has been advanced to the proper location, and then the two devices can be simultaneously withdrawn (preferably after the balloon has been at least partially inflated), leaving the balloon in place.
- Selection of the appropriate balloon configuration for a particular procedure may depend upo the configuration of the device (80), including whether the presence of the balloon shaft (42) (whether or not it is attached to the balloon wall) significantly reduces the effective diameter of the balloon and therefore the maximum size of the device (80) that can be introduced through the balloon.
- the distal end (42) of the balloon shaft includes engagement means for engaging and disengaging the shaft (42) to and from the distal end of the balloon.
- This engagement means may comprise any suitable mechanism.
- Complementary threads may be formed on the distal end (44) of the shaft (42) and on the balloon distal fitting (36), as shown in FIG. 15. Alternately, a friction fit may simply be utilized between these two parts, as shown in FIG. 16. In yet another embodiment, shown in FIGS.
- the distal end (44) merely abuts the balloon distal fitting (36), the shaft's distal end (44) being loosely received in the distal portion of the balloon which tapers to a narrow end--as the balloon shaft (42) is advanced, it pushes against the fitting (36), but the shaft (42) can be easily withdrawn without having to physically uncouple it from the balloon.
- a complementary cup-shaped portion can be formed in the fitting (36), but such is not necessary.
- Other eguivalent mechanisms may also be utilized.
- the engagement means should be such that the shaft (42) can be disengaged for removal without placing undue stress on the balloon (33).
- the introduction chamber (50) may simply be the proximal end of the balloon (33). In most cases, however, it is desirable that the chamber (50) be manufactured from a suitable rigid material. Preferably, the chamber (50) is made of a transparent but rigid plastic material permitting visual inspection of the device housed in tile main chamber (52) as well as the presence or absence of fluid, air, or other substances. Assemblies such as the introduction chamber (50) are well known, freguently referred to as "Y-connectors.” Similarly, the compression fittings (54) and (61) on the introduction chamber (50) are also well known.
- the introduction chamber (50) may also include means for permitting withdrawal of air from the chamber, either through a bleedable port, or by inserting a hypodermic needle through a rubber seal, or any other suitable means. Air may also be bled from the chamber (50) by loosening the fitting (54). By orienting the entire device and the patient so that any air in it rises into the introduction chamber (50) the air can be bled off, preventing it from being released into the patient when the balloon is ruptured.
- FIG. 26 shows a simplified version in which only a single fluid port (66) is utilized.
- the balloon shaft (42) may be withdrawn and the introduction chamber fitting (54) removed and replaced with a fitting (54') assembled to the device (80), whereupon the balloon may be inflated.
- the same fitting (54) may be utilized if the fitting (54) can be advanced over the proximal end of the delivery shaft (81) (sometimes this may be inhibited by other apparatus that has been attached to the shaft's (81) proximal end, reguiring pre-assembly of a fitting (54') on the shaft), and if the outer diameters of the balloon shaft (42) and the device delivery shaft (81) are close in diameter.
- the inflation device may comprise any suitable inflation device such as those typically used in balloon angioplasty.
- the inflation device (69) will include a syringe (71) having a plunger (72) for expelling the fluid (77) into the balloon (33). If needed to increase the capacity of the inflation device, a plurality of syringes may be used in parallel, permitting one to be replenished with fluid when the other is in use.
- a stop-cock (73) may be provided to maintain pressure on the system.
- a pressure gauge (not shown) may also be utilized to precisely monitor the amount of pressure in the balloon (33). A good synopsis of these traditional angioplasty supplies appears in T. Ischinger, Practice of Coronary Angioplasty, Chapter 7 (1986).
- the inflation fluid (77) should be a biocompatible fluid, such as saline, since some of the fluid will enter the passageway when the balloon is ruptured.
- a biocompatible fluid such as saline
- either a saline/anticoagulant (such as heparin) mixture and/or radiographic contrast solutions and/or other biocompatible fluids may be utilized.
- the volume of fluid (77) actually introduced into the body is small enough that such solutions will suffice.
- plasr1a or whole blood could be utilized as the fluid, though this normally would not be necessary.
- an isolating balloon (90) is provided within the introduction balloon (33) proximally cf the device (80), but preferably coaxially of the device delivery shaft (81). After the device (80) has been advanced into the aorta (20), the isolating balloon (90) can be advanced to a pcsition just proximal of the device (80).
- the isolating balloon (90) When so positioned, the isolating balloon (90) can be inflated, as shown in FIG. 28 by injecting fluid from the inflation syringe (96) through the inflation lumen (92). Fluid (77) can then be withdrawn from the proximal portion of the introduction balloon (33) into inflation device (69) without releasing pressure in the distal end portion of the balloon (33) (see FIG. 29). The distal end portion of the balloon (33) can then be ruptured by overpressure supplied by an additional syringe (98) injecting fluid through a second lumen (93) in the isolation balloon shaft that delivers the fluid distally of the isolation balloon (90).
- an additional syringe (98) injecting fluid through a second lumen (93) in the isolation balloon shaft that delivers the fluid distally of the isolation balloon (90).
- FIG. 30 shows yet a further embodiment, similar to the embodiment of FIGS. 27-29, but slightly simpler.
- the inflation device (69) is connected directly to the central lumen (93) of the isolating balloon (90), eliminating the need for the separat(syringe (98) of FIGS. 27-29.
- the inflation device serves initially to inflate the entire introduction balloon (33) to permit advancement of the device (80) into the distal portion of the balloon (33). Prior to inflation of the isolation balloon however, the entire introduction balloon (33) is deflated by withdrawing fluid into the inflation device (69).
- the isolation balloon (90) may be inflated, causing the inflation device (69) to be in connection only with the distal end portion of the balloon (33); overpressure supplied by the inflation device (69) will then rupture the distal portion of the balloon (33), freeing the device (80) from the balloon.
- the device (80) to be delivered through the introduction balloon catheter of the invention may be of virtually any type, and it is contemplated that a wide variety of devices could be utilized.
- One of the possible uses is the delivery of devices to the heart through the femoral artery.
- temporary cardiac assist pumps have been proposed for use in patients having cardiogenic shock following acute myocardial infarction, or in patients who have failed to wean from cardio-pulmonary bypass. Insertion of such a pump through the femoral artery has in a significant percentage of cases been difficult or impossible due to vascular disease that has impeded or blocked advancement of the pump beyond the aortoiliac junction. See, e.g., P. Rutan, et.
- This pump consists of an elongated cylindrical tube in which a propeller/impeller rotates to propel blood therethrough.
- the pump typically would be positioned in the descending aortic arch, passing through the aortic valve into the left ventricle, thereby pumping oxygenated blood from the left ventricle into the aorta.
- the pump preferably is delivered to the aorta and heart by introduction through the femoral artery.
- An obvious limitation of the capacity of the pump is its diameter, and this in turn is limited by the size of the femoral artery.
- the proposed solution to delivery of the pump through disease-restricted arteries is to decrease the diameter of the pump. Utilizing the introduction balloon catheter of the invention facilitates introduction of the pump into the arteries and also alleviates the need to decrease the diameter of such a pump (and might even allow a slight increase in such diameter).
- the device (80) depicted in the drawings is shown somewhat schematically to represent any type of device that might be delivered into a passageway, and is not intended to depict any particular device (though its relative size and configuration is not unlike the aforementioned pump).
- consideration must be given to the ability of fluid (77) to either flow around or through the device (80) as the device (80) is advanced through the inflated balloon (33) to avoid excessive pressure build-up distally of the device (80), and therefore to avoid premature rupture of the balloon (33).
- FIG. 13 shows an alternative embodiment of the introduction balloon catheter of the invention.
- the device (80) itself (a large bore catheter, for example) includes a central lumen through which the inflation fluid (77) is injected into the balloon (33), thereby alleviating the need for a separate fluid port (66).
- the device delivery shaft (81) could include a lumen with a port adjacent the proximal end of the device itself (not shown).
- FIGS. 14 and 14A show yet another embodiment wherein the balloon shaft (42) includes a central lumen through which the fluid (77) is injected into the balloon (33).
- the central lumen has an outlet port or ports near its distal end (44) so that fluid may be injected even when the shaft is almost completely withdrawn through the shaft port (60).
- FIG. 31 shows yet a further embodiment where the device delivery shaft (81) is supported by a stiffening shaft (82) to aid in advancing the device (80) through the passageway--in many cases this shaft (82) need only be long enough to help push the device (80) through the balloon (33) into the aorta (20), following which the delivery shaft (81) may be advanced alone to deliver the device to its destination.
- a fitting (83) may be provided to seal the stiffening shaft (82) about the delivery shaft (81).
- FIGS. 38-39 show yet a further embodiment in which the device to be delivered through the balloon catheter is a large bore catheter, such as the type used in a cardiopulmonary bypass support system.
- a cardiopulmonary bypass support system typically provide cardiopulmonary bypass through the femoral vein and artery to oxygenate and pump blood during cardiac arrest, acute heart failure, or similar emergency situations.
- Full discussion of these procedures can be found in, e.g., F. Shawl, "Emergency Cardiopulmonary Bypass Support in Patients With Cardiac Arrest in the Catheterization Laboratory,” Catheterization and Cardiovascular Diagnosis 19:8-12 (1990).
- a catheter or cannula typically is inserted into the femoral artery and the femoral vein to establish circulation through the external oxygenator/blood pump.
- venous access is not usually problematical, if a patient is atherosclerotic, arterial access may be difficult or impossible.
- the balloon catheter (33) of the invention has been ruptured after its insertion, inflation, and advancement of the arterial access cannula (84) of a cardiopulmonary bypass support system.
- blood which has been withdrawn from a seperate venous access cannula (not shown) has been oxygenated and is being pumped back into the aorta (20) through the arterial access cannula (84).
- the distal end of the cannula (84) can be advanced as far as desired in the femoral/iliac artery and the aorta (20), or need not be advanced out of the end of the ruptured balloon, as desired.
- removal of the ruptured balloon is not necessary until the cannula (84) itself is removed, and, in fact, the ruptured balloon can be used to help withdraw the cannula (84).
- the fluid (77) in the inflation device (69) is a saline/anticoagulant (such as heparin) mixture which can be injected in small amounts from time to time to prevent coagulation in and about the ruptured balloon.
- FIG. 39 illustrates the utility of the balloon catheter (33) of the invention in assisting repositioning or removal of the cannula (84).
- fluid (77) is being forcefully pumped into the ruptured balloon (33) by the inflation device (69).
- the distal rupture of the balloon allows some of the fluid (77) to escape into the vascular system, a forceful injection of fluid (77) will cause at least the proximal and intermediate portions of the balloon to inflate somewhat--at least enough to allow the fluid (77) to travel distally toward the rupture.
- the balloon may not entirely inflate, the presence and passage of the fluid through the balloon will lubricate the interface between the balloon (33) and the outer surface of the cannula (84) sufficiently to allow the cannula (84) to be repositioned or withdrawn without damage to or friction with the wall of the artery (22).
- the compression fitting (54) may be loosened slightly to permit easier advancement or withdrawal of the cannula (84), as shown in FIG. 39. Once the cannula (84) has been withdrawn, the balloon can easily be deflated and withdrawn.
- the bodily passageway through which a device (80) is to be inserted is selected, and determination of the diameter and length of that passageway is made through conventional radiology technigues, such as angiography and the like.
- An appropriate size introduction balloon catheter, both in diameter and length, is then selected.
- Appropriate anesthesia may be administered to the patient, if necessary, and entry to the passageway is obtaired.
- a vascular graft may be sutured to the artery or vein after performing a cutdown procedure, or, in certain circumstances, access to the vessel may be obtained through a percutaneous puncture, as by using the Seldinger technigue (though normally a cutdown procedure will be used due to the size of the balloon selected).
- the guidewire (37) is then advanced into the passageway. followed by introduction of the deflated balloon (33).
- the balloon is inflated by operation of the inflation device (69), which injects fluid (77) into the balloon (33).
- the balloon shaft (42) may then be removed (or merely retracted). if desired.
- the device (80) may then be advanced into the balloon by advancing the device delivery shaft (81) through the ring (57) of the introduction chamber's (50) threaded compression fitting (54). This fitting may be lcosened slightly to facilitate advancement of the delivery shaft (81), and then tightened again to reduce leakage once the device (80) has reached its destination in the balloon (33).
- the balloon may be ruptured to free the device (80) from the balloon (33).
- rupture typically may be accomplished by providing over-pressure to the balloon to burst it in a longitudinal fashion near its distal end (34).
- the device (80) may then be further advanced into the passageway, and the balloon (33) may be withdrawn from the passageway.
Abstract
Description
Claims (32)
Priority Applications (6)
Application Number | Priority Date | Filing Date | Title |
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US07/643,919 US5221258A (en) | 1991-01-22 | 1991-01-22 | Introduction balloon catheter |
EP19920904906 EP0568625A4 (en) | 1991-01-22 | 1992-01-21 | Introduction balloon catheter |
CA002100877A CA2100877A1 (en) | 1991-01-22 | 1992-01-21 | Introduction balloon catheter |
AU12484/92A AU652324B2 (en) | 1991-01-22 | 1992-01-21 | Introduction balloon catheter |
PCT/US1992/000494 WO1992012755A1 (en) | 1991-01-22 | 1992-01-21 | Introduction balloon catheter |
JP4505404A JPH06504472A (en) | 1991-01-22 | 1992-01-21 | introduction balloon catheter |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US07/643,919 US5221258A (en) | 1991-01-22 | 1991-01-22 | Introduction balloon catheter |
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US5221258A true US5221258A (en) | 1993-06-22 |
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US07/643,919 Expired - Lifetime US5221258A (en) | 1991-01-22 | 1991-01-22 | Introduction balloon catheter |
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US (1) | US5221258A (en) |
EP (1) | EP0568625A4 (en) |
JP (1) | JPH06504472A (en) |
AU (1) | AU652324B2 (en) |
CA (1) | CA2100877A1 (en) |
WO (1) | WO1992012755A1 (en) |
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Also Published As
Publication number | Publication date |
---|---|
AU1248492A (en) | 1992-08-27 |
JPH06504472A (en) | 1994-05-26 |
EP0568625A1 (en) | 1993-11-10 |
AU652324B2 (en) | 1994-08-18 |
EP0568625A4 (en) | 1993-12-01 |
CA2100877A1 (en) | 1992-07-23 |
WO1992012755A1 (en) | 1992-08-06 |
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